In August of 2008, the Salem Enterprise Zone (SEZ)Board entered into agreement with Purdue University’s Health Care Technical Assistance Program (HTAP), Washington County Economic Growth Partnership (WCEGP) and Washington County Memorial Hospital (WCMH) for the purpose of analyzing WCMH and identifying strengths and weaknesses in the operation as well as setting the stage to build on the strengths and take corrective action on the weaknesses. The cost of the HTAP study was $50,000, paid with taxpayer money through SEZ and WCEGP.
On February 6, 2009, representatives of the HTAP program met with WCMH executives and Board of Trustees members, representatives from SEZ and WCEGP, as well as several elected officials. Those individuals were presented with a summary or overview of the HTAP survey; the meeting was not open to the public or the media.
On February 9, 2009, an email was sent to local newspapers stating that legal counsels for WCMH and Saint Vincent Health would have to review the HTAP survey to determine if any confidential or privileged information existed in it; anticipated completion date for said review was set for March 6, 2009. The email went on to state that, “Once this review has been completed, a joint press release will be issued by the hospital and the Growth Partnership with that part of the detailed report which can be released.” (As of Monday morning, March 9, no such report or announcement has been issued.)
The WCMH Board of Trustees met in regular session on Thursday, February 26. At that meeting, the question was asked regarding when the HTAP report and results, in their entirety, would be made public. Board President, Aaron Lee stated that once attorneys for WCMH and St. Vincent Health have reviewed the survey, a pubic statement would be made. When pressed as to when that statement would be forthcoming, the answer was, “Soon.” A final question concerning the release of the survey focused on the possible opinion from attorneys that no privileged information is contained in the survey: “If it is determined that release of the HTAP survey in its entirely does not violate HEPA laws (patient confidentiality)or laws derived from Department of Homeland Security directives regarding Emergency Preparedness plans, will the survey be made public?”
Dr. Steven Kemker replied to the question by saying, “ WCEGP, WCMH, and St. Vincent Health would all have to agree to make it public.”
One possible explanation for what appears to be an effort to postpone the public release of the information in the HTAP survey can be found in the second paragraph of the “Conclusions/Recommendations” section on page # 33 of the survey:“The Hospital and its systems have failed Washington County and are potentially compromising the health of the citizens. This failure has potentially decreased the economic development opportunities for the city of Salem and the entire county.”
It should be stated that not all the information and findings contained in the HTAP survey are negative. On page # 6 of the survey, addressing results of surveys conducted on patients, physicians and employees it states, “The inpatient satisfaction scores ranked the hospital above other peer hospitals in almost all categories.”
Another positive statement can be found on page # 13 of the survey:“It is obvious to the HTAP Team each of these individuals (community members, Board of Trustees, County Commissioners, hospital employees and medical staff) are truly vested in the community and the well-being of the hospital.”
In addition, several times throughout the report, the dedication and strong commitment to quality patient care by most hospital employees are noted. However, that praise is tempered with concern that those employees are working in a “culture of fear of retribution for reporting quality of care and patient safety issues.”(HTAP survey 23).
Outside of the previously noted positive comments in the report, little else can be seen as strengths upon which to build. If fact, throughout the report, a pattern emerges depicting an environment in which there is a perception of a lack of trust, a lack of transparency, a lack of confidence, and and a lack of consistent messaging on the part of the Board of Trustees, Chief Operating Officer, and hospital leadership (HTAP survey 14-15).
The themes of poor communication and lack of transparency continue on page #19 of the survey:“Multiple interviews (with Board members) revealed the hospital Board is required to make decisions with incomplete or inaccurate information.”
“A lack of an effective forum for communications from administration to employees.”
“County Commissioners have requested financial reports be provided on a quarterly basis though they do not receive them.”
“County Commissioners, the Medical Director, and hospital Board members were not aware of the Indiana State Department of Health Survey ( ISDHS) that was completed in April of 2008, which is publicly available (online at http://www.in.gov/isdh/reports/QAMIS/acc/hosrpt/ha005087.htm and http://www.in.gov/isdh/reports/QAMIS/acc/hosrpt/s1005087.htm.)”
The aforementioned ISDHS notes 19 citations at WCMH which is 171 per cent greater than the average number of citations for hospitals across the state. Of the 19 citations nearly one-third involved the responsibilities of the Board of Trustees and Chief Executive Officer. According to information on page # 20 of the HTAP survey, the April 22, 2008 ISDHS concerns “involved many serious citations related to the quality of care . . .It is important to note that the potential risks related to the citations are significant, as is sheer number of citations identified in the survey.” Those citations range from a lack of documentation for medical procedures to the use of expired medical equipment and supplies to questionable cleaning and disinfection techniques.
The HTAP survey also cites another report noting opportunities for improving the quality of patient care. HTAP points to the February 2008 CNA Confidential Report of Risk Assessment by stating, “ . . . the potential and/or actual risk associated with the findings of the risk control assessment are significant and should be considered extremely serious.”
The HTAP survey goes on to state, “It is the understanding of HTAP that the CNA report was received by WCMH in August of 2008 and that there is currently (as of February 6) no written plan in place indicating the actions WCMH intends to take regarding the findings and recommendations from this report.
Failure to address the outcomes of the State and CNA reports and comply with these reports' findings places the hospital's insurance coverage and licensure at risk and could potentially lead to a negative follow-up visit from the State and is thus detrimental to the viability of the hospital.”( HTAP survey 21-22).
Yet another recent report seems to come to the same conclusion about WCMH. On page # 22 of the HTAP report, reference is made to the HealthGrades Report dated for 2005-2007. The patient safety ratings by Healthgrades reflect the quality of care by measuring how well potentially preventable hospital-acquired complications and adverse events are avoided. The HealthGrades Report is accessible at http://healthgrades.com/hospital-directory/indiana-in/patient-safety-GST9DEDE46E151314.
Ratings for this report include “Worse”, “ Average”, and “Better”. The report addresses thirteen categories of which WCMH received an “Average” rating on nine of those categories. However, of special concern are the four areas in which WCMH scored worse than what would be expected for a hospital of comparable size:Prevention of death in procedures where mortality is usually very low.
Ability to diagnose and treat in time.
Avoidance of respiratory failure following surgery.
Lack of surgical wound site breakdown.
In conclusion, ever since WCMH opened its doors in 1950 its core mission has been to provide quality medical care to those who live and work in Washington County. If the HTAP survey along with the other aforementioned studies and surveys are to be believed, that mission may well be in jeopardy in 2009.